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Aortic stenosis is a narrowing of the aortic valve by calcification, usually occurring in older people or those with congenital defects in aortic valve formation. When the valve gets too narrow, the heart has to pump extra hard to force blood into the aorta and into the rest of the body. Eventually heart failure, chest pain or passing out will occur, ultimately leading to death unless the valve is surgically replaced.

Until now, older people who were too ill to undergo open heart surgery to replace the valve would die. A new procedure has arrived, allowing for valve replacement without opening the chest and putting the patient on a heart-lung machine. A special catheter is threaded up the aorta from entry in the groin artery. An artificial valve at the end of the catheter is placed carefully and exactly within the orifice of the aortic valve, then expanded by inflation of a balloon. The calcified natural valve is pushed against the sides of the aorta, and the new valve is fixed in place, allowing for a larger passage.

I saw the procedure demonstrated at a recent conference at Scripps Medical Center in San Diego, one of only 21 centers in the United States with approval to use the new device. One patient was 102 years old, smiling after surgery because he could walk again without a walker, and without oxygen.

It is a marvelous technique, and will prolong many lives that would previously have been lost.

Allan Sosin, M.D.

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